On Wed, 3 Jun 1998 15:33:22 GMT, Graham Ride wrote:

>As a potential patient, devil's advocate and Jo Public I need to know, in a
>nutshell, what the governments PCG proposal is so that I can assess why you
>say all these things will obtain.

PCGs are Bad for Patients,  Bad for Doctors and Bad for Britain.

Here is the first batch of 5 reasons why this is so:

>>1.  Postcode discrimination continues

-  everybody agrees that fundholding created a 2 tier service
-  that meant that the quality you got depended on where you lived
-  PCGs are like fundholding for everybody except that they are much
bigger
-  there will be about 500 PCGs created in England
-  if you live in areas where there are experienced people in buying
and managing services,  you'll do better than if you lived in areas
where there is no such experience
-  this is made worse by the fact that at present,  you can walk away
from bad service and move to another Surgery nearby
-  in the proposed scheme,  all doctors in your area will have to form
one big service.  To move doctor,  you'll have to move house well
outside your area


>>2.  Divisions and disputes amongst family doctors could have an impact
>>on delivery of care

-  because doctors work independently by contracting their services to
the NHS (and you),  they tended to concentrate on trying to give you, 
their patient the best service they can
-  under the new proposals,  doctors will lose that independence by
being forced into groups of 50 or more doctors whether they like
working with each other or not
-  in many areas,  especially inner cities and border towns and
villages the problems will be compounded
-  in inner cities,  many partnerships have broken down.  As a result, 
there is a large number of single and 2 doctors Surgeries.
-  these,  ex-partners,  will be forced into working together again. 
It's like going back to live with your ex-wife after divorce when each
of you has started a new life elsewhere
-  in border areas,  your doctor may have to deal with more than one
health authority and hospital
-  under the imposed new regime,  your doctor will have to go with the
rest of the group.  This could have an effect on where you receive
treatment or may involve changes to the way you received those services
-  because doctors will have to police each other in the proposed
arrangement and may have to force each other to accept things like
reduced staff levels or cuts in infrastructure support,  this will lead
to endless disputes between doctors that can embroil them in long
battles with each other and distract them from concentrating on the
services they provide to you


>>3.  No time for doctors to do doctoring

-  next time you try to see your doctor,  he or she may not be there
because they will have to attend endless meetings.  They will be just
like civil servants and administrators
-  because running large multi-million pounds organisations (which the
PCGs will be),  doctors will have to spend a lot of time learning and
training for things they were never meant to do
-  because doctors will be under constant pressure to watch the pennies
and pounds (because they are now in charge of all the budget for health
care),  they will be forced to prescribe less,  not prescribe expensive
treatments,  refer less to hospitals for specialist treatment and look
at ways of saving money
-  at the same time,  they will be inheriting large amounts of debts
from health authorities and hospitals as well as having to pay cost of
litigation and compensation against those authorities and hospitals
both past and future cases,  they may be forced to practise what is
called 'defensive medicine' with lots of un-neccessary intervention and
operations to avoid liability
-  all that will lead to doctors' minds being on other things all the
time thus reducing the time available to provide you with quality care
>>4.  Increased rationing

-  family doctors in Britain have always enjoyed protection for their
personal investment in the infrastructure of the NHS.  Things like
surgery buildings and equipment,  reception and nursing staff and the
latest technology to serve you better
-  this infrastructure is supported,  in part,  by a protected budget
-  the new arrangements will remove that protection
-  doctors might find themselves in a situation of conflict of interest
-  for example,  when faced with budget shortfall,  do they provide
more hip operations for the elderly in their area or cut their staff
numbers?
-  we all know that the NHS is not funded adequately,  therefore, 
these budget shortfalls are bound to happen
-  you only need to look at the lengthening waiting lists despite the
little injection of cash to see what I mean
-  all  this will lead to constant pressure on what services to provide
and at what cost
-  this is what is called rationing of services
-  the people who usually suffer from rationing of services are those
considered to be 'expensive' patients like the elderly and chronically
sick

>>5.  Loss of the patient advocate role played by family doctors

-  family doctors in Britain have always been your advocate
-  they speak on your behalf to bring your concerns to the government
and the managers of the NHS
-  they also play an important role in being on your side in cases of
disputes with social services and the DSS
-  your family doctor always has your interest and your interest only
at heart,  he or she has no axes to grind except to defend your rights
to decent health care
-  this important role that family doctors played for generations will
be under threat when they assume all responsibility for buying
services,  spending your money and settling disputes amongst themselves
-  also,  family doctors will always have to watch their backs as the
government and the managers apply pressure on them to cut costs
-  remember,  the independence of your family doctor to prescribe, 
refer and speak up for what is best for you will be gone
-  just like your friendly independent small shop has gone to give way
to impersonal hypermarkets

We continue to expose these threats to patient care with the second
batch of 5 reasons why PCGs are Bad for Patients,  Bad for Doctors and
Bad for Britain tomorrow (in sha' Allah)

The Major


________________________________________

Dr Ahmad Risk
http://mednetics.org
home: +44 1273 724866
work:  +44 1737 240022
fax:     +44 1737 244660




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